Direct to implant breast reconstruction by using SERI, preliminary report

Abstract

Background: There has been a "rising tide" in mastectomy utilization that can be attributed to more skin-sparing mastectomies (SSMs) performed concurrently with immediate breast reconstruction. We report our experience of the first use of SERI Surgical Scaffold (SERI; Allergan, Inc.) in 21 cases of direct to implant (DTI) breast reconstruction after SSM.

Methods: Our retrospective experience, from April 2013 to May 2014, is based on 21 cases of direct to implant (DTI) breast reconstruction after SSM (9 monolateral 6 bilateral). All the patients were oncological with a preoperative cancer stage was into 0-2 stage. In order to assess the level of satisfaction with the aesthetical result, on 4-13 months post-operative patients were asked to complete a questionnaire that evaluated various parameters by means of a Visual Analogue Scale (V.A.S.).

Results: Over a 13-months period, a total of 15 patients underwent 21 immediate breast reconstructive procedures with Allergan Natrelle 410 style implants plus SERI after SSMs. Definitive histological examination give evidence of 5 patients intraductal carcinoma, 6 patients multifocal carcinoma and 4 patients carcinoma in situ. 6 bilateral cases of direct to implant (DTI) breast reconstruction after SSM had a monolateral oncological treatment and on the other side a prophylactic treatment. At the end of the short follow up (minimum 6 months) all the patient were cancer free with an excellent outcome. Complication rate presents just one implant exposure followed by a revised surgery. At V.A.S. the mean patient satisfaction was 5,77 (good), 4,09 (fair) for sensitivity of the nipple areola complex, 6,33 (good) assessment of implant position, 6,28 (good) self esteem, 5,2 (good) attraction ability, 4,99 (fair) intimate life, 6,81 (good) overall feelings about breast reconstruction, 6,71 (good) simmetry.

Conclusions: The really encouraging results of our early experience will help surgeons introducing SERI into their practice to select appropriate patients for direct-to-implant single-stage immediate breast reconstruction. A larger study cohort and longer follow-up times are required to identify additional predictors and indications.

Figures

Figure 1

Case 1. A: 39 YO nulliparous, preoperative view, grade 1 intraductal carcinoma on the right breast. B: Right breast: therapeutic nipple skin sparing mastectomy direct to implant Allergan 410 Style FF 425 and SERI®. 3 weeks postop. C: 5 months postop.

Figure 2

Case 2. A: 45 YO, preoperative view, previous quadrantectomy without Radiotherapy on the right breast, grade 1 multifocal carcinoma on the left breast. B: Left breast: therapeutic nipple skin sparing mastectomy direct to implant Allergan 410 Style MF 420 and SERI®. 2 weeks postop. Right breast: prophylactic nipple skin sparing mastectomy direct to implant Allergan 410 Style MF 420 and SERI®. 2 weeks postop. C: 4 months postop.

Figure 3

Case 3. A: 51 YO, preoperative view, previous biopsy grade 2 intraductal carcinoma on the left breast. B: Therapeutic nipple skin sparing mastectomy direct to implant Allergan 410 Style MF 375 and SERI®. 3 weeks postop, initial skin suffering. C: 2 months postop implant and SERI® exposure before reoperation. D: 7 months postop after implant explantation and Latissimus dorsi miocutaneous flap as a salvage procedure with Allergan 410 MF 335.